Information Obtained on Initial Contact

INFORMATION OBTAINED ON INITIAL CONTACT WITH PROPERTY OWNER AND SEARCH OF PUBLIC RECORDS TIP/Parcel No.: WBS ELEMENT: COUNTY: Claim of: FA Project: Property Address: Tax Parcel: Block/Lot or Pin: Township Tax Parcel: Block/Lot or Pin: Township Tax Parcel: Block/Lot or Pin: Township Deed Recorded - Date Book-Page Stamps Deed Recorded - Date Book-Page Stamps Deed Recorded - Date Book-Page Stamps Deed Recorded - Date Book-Page Stamps Plats/Maps of the Property Out Conveyances Book- Acreage Plat/Map Book-Page Page Conveyed Book- Acreage Plat/Map Book-Page Page Conveyed Book- Acreage Plat/Map Book-Page Page Conveyed Property Bounded by on the: Existing Easements on the Property: Book- North Held By: Page Book- South Held By: Page Book- East Held By: Page Book- West Held By: Page If no deed to present owner: Previous Deed recorded in Book- Date of death of previous Page owner Previous Owner’s Estate File No. Spouse of previous Owner If no estate file, create/attached list of heirs and heir’s physical addresses since last recorded deed, including relationship to deceased. Total Acreage indicated by Total Acreage indicated by Deed/Will AC. Tax/GIS AC. Total Acreage on Appraisal DEED/WILL TAX/GIS CADD Request from OTHER List all owners and spouses, including heirs and owner’s phone/addresses (physical address if in NC). Add lines if necessary. Owner Name Phone Address

List all Roads Adjoining the Parcel (include any other means of access to the parcel) : Road Road Number Name Road Road Number Name

FRM4-H Revised 03/03/14 Road Road Number Name Road Road Number Name List Names/Addresses of any persons who cross the subject parcel to access other lands, whether they have an easement or not : If property owned by a trust, obtain copy of Trust Agreement and list name(s) of trustees authorized to convey real estate:

If property owned by a corporation or LLC, check status at http://www.secretary.state.nc.us/corporations/csearch.aspx Encumbrances: List Mortgages, Deeds of Trust, Leases, Special Proceedings, Bankruptcy Proceedings, Judgments, Tax Liens, other Liens or Civil Actions affecting the property:

R/W AGENT RIGHT OF WAY AGENT DATE: SIGNATURE: (Type Name Here)

FRM4-C Revised 09-04-13